Health plans have spent years and millions of dollars acquiring or replacing information systems but a lack of alignment between companies’ business and IT organizations is hamstringing the industry, according to a June 11 panel at America’s Health Insurance Plans Institute 2014 in Seattle.
Shaun Flanagan, senior vice president at Optum, the health services business of UnitedHealth Group, argues that technology alone cannot transform an organization and that a health plan’s business and IT staff must “think alike” working towards a common integrated goal.
“People that work with the technology and business and operations tied together are the fuel for the transformation,” says Flanagan. “Your IT people need to know business-functional knowledge so that they can be a much more impactful, valuable partner to the business.”
Ray Desrochers, executive vice president at payer software vendor HealthEdge, advises that “technology for the sake of technology has no value.” Desrochers says that planning, strategy and design go a long way toward achieving organizational objectives.
Flanagan believes progressive companies that recognize the importance of data and have data governance and stewardship programs are going to be the ones that lead the industry. “It’s the unclean data and unclean set-up of core administrative systems that gunk up these systems and make them wholly inefficient,” he says.
The configuration of core administrative systems, in particular, is critical, according to Flanagan. Data sitting in a core system drives new business models such as accountable care organizations, value-based reimbursement, and pay-for-performance, he asserts.
“If you don’t have your data right at the source coming into your core system, nothing will prevent you from all the ills that it is going to cause,” Flanagan warns. “There’s gold there and if you can’t get that data out from an integration services layer you’re really going to miss the chance to mine what those programs promise to achieve.”
Matt Kuntz, chief technology officer at HealthEdge, observes that the “right data” for providers to pay claims is not often correct. “In many cases, the systems that we are using and the ways that we have implemented them actually get in the way of getting the data right,” says Kuntz. “The right data for doing analytics, for communicating with providers, and for provider directories is not the right data for adjudicating the claims correctly.”
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